Provider Demographics
NPI:1790850659
Name:KEANEY, JESSICA ANN (MSPT)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ANN
Last Name:KEANEY
Suffix:
Gender:F
Credentials:MSPT
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Mailing Address - Street 1:825 WASHINGTON ST
Mailing Address - Street 2:PHYSICAL THERAPY & SPORTS REHAB INC STE 280
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062
Mailing Address - Country:US
Mailing Address - Phone:781-769-2040
Mailing Address - Fax:721-769-1914
Practice Address - Street 1:825 WASHINGTON ST
Practice Address - Street 2:PHYSICAL THERAPY & SPORTS REHAB INC STE 280
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062
Practice Address - Country:US
Practice Address - Phone:781-769-2040
Practice Address - Fax:721-769-1914
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA15259225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y68568OtherBC BS
466586OtherTUFTS
466586OtherTUFTS